Billy Timmins (Wicklow, Fine Gael)

I am sure somebody will. I recall the debate on the first-time buyer's grant during which I made a valuable point that only one third of first-time buyers received the grant because two thirds bought secondhand houses. Therefore, the grant was inequitable as well as not being index-linked and so on. That point was thrown back at me afterwards in isolation. I appeal for the point I have just made not to be taken in isolation, although it does not matter to me. I firmly believe what I have said to be the case. It is not Fine Gael Party policy but it should be examined. I do not make this suggestion for the purpose of trying to extract €1 from a person who cannot afford it, but it is the principle of making people aware of the cost.

The percentage of gross domestic product spent on health has increased dramatically. It is not inappropriate to devote a percentage of our GDP to health care as we become richer. The dilemma is judging what should be the appropriate level of spending. One of the risks associated with health care is excess spending. It would appear that some providers may have captured more than their fair share of the increase in health spending. As we can clearly see from those figures concerning drugs, some providers have received an inordinate share of the increase of the funding and it has not gone to the provision of care. Many countries have faced the same challenges as us over the decades. However, due to work practices and historical factors, the solutions may not necessarily be the same. When Ireland was a much poorer country there was less dissatisfaction with the health service than today.

There must be two pillars to the health service. A health service must provide quality care, access and value for money. We have quality care and access for some, but there is a disparity of access, which is one of the main difficulties. In addition, we do not have value for money, as evidenced by the percentage of funding that goes to providers as opposed to users. Countries that were more developed than us in the 1960s and 1970s spent an increasing amount of their GDP on health services. However, they realised they were not getting the benefits and, in the 1980s, they reformed and cut back on spending. We are going through that growing process in which we are trying to reform.

I am pleased the Minister alluded to the second pillar in one of the sections of the Bill. It must involve a recognition of behavioural and risk factors, such as cigarettes, alcohol, obesity, violence, a low social awareness of what is good for oneself, income distribution and the ability of people to purchase goods or services that help them in the first instance not to require health assistance. The clinical aspect plays a secondary role. I am pleased the Minister recognises that in the Bill because the health service is not only about provision but also prevention.

Time does not permit me to go through the sections of the Bill. In a nutshell, one of the difficulties we in Fine Gael have is that, although the reports have been published for a number of years, we do not have time to elaborate on the issues in a debate over one or two days. Other speakers referred to the role of the chief executive as the Accounting Officer. I agree as a public representative that we must have access to the information. I have attended too many public meetings in recent years, be they with the National Roads Authority or the Environmental Protection Agency where ultimately our hands were tied and we could find out nothing. The Minister said that our policy must be implemented, that a corporate plan and a national service plan must be produced by the chief executive and that they must be proofed on Government policy. We on this side want an assurance that there will be accountability to the House and that we will not be informed it is not within the remit of the Minister. There has been a failure in political society in recent years to take responsibility. We do not trust ourselves and we side-step issues instead of taking the blame. It is the same with An Bord Pleanála. If I were Minister for the Environment, Heritage and Local Government, I would abolish An Bord Pleanála and take the flack.

See this speech in context